Provider Demographics
NPI:1962444802
Name:GUPTA, ARUN KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:ARUN
Middle Name:KUMAR
Last Name:GUPTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1703 MERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1628
Mailing Address - Country:US
Mailing Address - Phone:516-378-3311
Mailing Address - Fax:516-546-1517
Practice Address - Street 1:1703 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-1628
Practice Address - Country:US
Practice Address - Phone:516-378-3311
Practice Address - Fax:516-546-1517
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161794207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00970076Medicaid
NY00970076Medicaid
NY71D611Medicare ID - Type Unspecified